title: Immunosupressive therapy in children with steroid-resistant nephrotic syndrome: single center experience.
abstract: BACKGROUND
  [corrected] Nephrotic syndrome is one of the most frequent glomerular diseases among children, and steroid therapy remains as the treatment choice. In spite of this, 10 to 15% of the patients are steroidresistant, and the best therapy for such cases has never been defined. Mycophenolate acid (MA) is one of the treatments used in such situations.
  
  
  OBJECTIVE
  To describe the clinical behavior of children diagnosed with steroid-resistant nephrotic syndrome (SRNS) and to assess the therapeutic response to MA.
  
  
  METHODS
  This was a retrospective and descriptive study.
  
  
  RESULTS
  26 clinical records of patients with SRNS; 70% male and 30% female. All patients underwent kidney biopsies, which showed a predominance of focal segmental glomerulosclerosis (FSGS). The immunosuppresive drugs used were: Mycophenolate mofetil (MMF) 100%, Cyclosporine 69.2%, Cyclophosphamide 23.1%, and Rituximab 23%. One month after treatment initiation with MMF 61.5% achieved remission. The median of relapses per year for the patients was 3 (p25: 2.75 - p75: 4). This median became 1 (p25: 1 - p75: 3.25) after using this medication (p = 0.08). Furthermore, prior to the start of the MMF treatment, the median of the steroid dose was 1 (p25: 0.5- p75: 1.62) mg/k/day. After using MMF, this median became 0.07 (p25: 0 - p75: 0.55) mg/k/day (p < 0.001), in 8 patients prednisolone was stopped.
  
  
  CONCLUSIONS
  In our experience, treatment with MMF showed positive results such as decrease in the frequency of relapses, less proteinuria, and reduction in the dose of steroids administered without deterioration of glomerular filtration rates. However, more studies are needed to assess efficacy, safety, and optimal dosage.
authors.forename: Catalina Velez
authors.initials: CV
authors.lastname: Echeverri
authors.forename: Gustavo Adolfo Zuluaga
authors.initials: GA
authors.lastname: Valencia
authors.forename: Lina Maria Serna
authors.initials: LM
authors.lastname: Higuita
authors.forename: Ana Katherina Serrano
authors.initials: AK
authors.lastname: Gayubo
authors.forename: Carolina Lucia
authors.initials: CL
authors.lastname: Ochoa
authors.forename: Luisa Fernanda Rojas
authors.initials: LF
authors.lastname: Rosas
authors.forename: Laura Carolina
authors.initials: LC
authors.lastname: Muñoz
authors.forename: Javier
authors.initials: J
authors.lastname: Sierra
authors.forename: Jhon Jairo
authors.initials: JJ
authors.lastname: Zuleta
authors.forename: Juan José Vanegas
authors.initials: JJ
authors.lastname: Ruiz
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use*; D007223:Infant; D008297:Male; D009173:Mycophenolic Acid / Q000031:analogs & derivatives* / Q000627:therapeutic use; D009404:Nephrotic Syndrome / Q000151:congenital* / Q000188:drug therapy; D012189:Retrospective Studies
chemical_list: D007166:Immunosuppressive Agents; D009173:Mycophenolic Acid